Abstract
The Patient-Centered Medical Home (PCMH) is a model of care that has been promoted as a way to transform a broken primary care system in the US. However, in order to convince more practices to make the transformation and to properly reimburse practices who are PCMHs, valid and reliable data are needed. Data that capture patient experiences in a PCMH is valuable, but which instrument should be used remains unclear. Our study aims to compare the validity and reliability of two national PCMH instruments. Telephone surveys were conducted with children who receive care from 20 pediatric practices across Florida (n = 990). All of the children are eligible for Medicaid or the Children’s Health Insurance Program. Analyses were conducted to compare the Consumer Assessment of Health Plan Survey–Patient-Centered Medical Home (CAHPS–PCMH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN) medical home domain. Respondents were mainly White non-Hispanic, female, under 35 years old, and from a two-parent household. The NS-CSHCN outperformed the CAHPS–PCMH in regard to scale reliability (Cronbach’s alpha coefficients all ≥0.81 vs. 0.56–0.85, respectively). In regard to item-domain convergence and discriminant validity the CAHPS–PCMH fared better than the NS-CSHCN (range of convergence 0.66–0.93 vs. 0.32–1.00). The CAHPS–PCMH did not correspond to the scale structure in construct validity testing. Neither instrument performed well in the known-groups validity tests. No clear best instrument was determined. Further revision and calibration may be needed to accurately assess patient experiences in the PCMH.
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References
American Academy of Pediatrics, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. (2002). Policy statement: The medical home. Pediatrics, 110(1), 184–186.
American Academy of Family Physicians. (2008). Joint principles of the patient centered medical home. Delaware Medical Journal, 80(1), 21–22.
Homer, C. J., Klatka, K., Romm, D., Kuhlthau, K., Bloom, S., Newacheck, P., et al. (2008). A review of the evidence for the medical home for children with special health care needs. Pediatrics, 122(4), e922–e937.
Ferrante, J. M., Balasubramanium, B. A., Hudson, S. V., & Crabtree, B. F. (2010). Principles of the patient-centered medical home and preventive services delivery. Annals of Family Medicine, 8(2), 108–116.
Jaen, C. R., Ferrer, R. L., Miller, W. L., Palmer, R. F., Wood, R., Davila, M., et al. (2010). Patients outcomes at 26 months in the patient-centered medical home demonstration project. Annals of Family Medicine, 8(Suppl. 1), S57–S92.
Reid, R. J., Coleman, K., Johnson, E. A., Fishman, P. A., Hsu, C., Soman, M. P., et al. (2010). The group health medical home at year 2: Cost savings, higher patient satisfaction, and less burnout for providers. Health Affairs, 29(5), 835–843.
(2011). The Patient-Centered Medical Home Evaluators’ Collaborative. New York (NY): The Commonwealth Fund; [updated 2012 May 18; cited 2012 October 5]. http://www.commonwealthfund.org/Publications/Other/2010/PCMH-Evaluators-Collaborative.aspx.
McManus, M. A., Pollack, L. R., Cooley, W. C., McAllister, J. W., Lotstein, D., Strickland, B., Mann, M. Y. (2013). Current status of transition preparation among youth with special needs in the United States. Pediatrics. Published online May 13, 2013. http://pediatrics.aappublications.org/content/early/recent. Accessed on May 15, 2013.
Boudreau, A. D., Van Cleave, J. M., Gnanasekaran, S. K., Kurowski, D. S., & Kuhlthau, K. A. (2012). The medical home: Relationships with family functioning for children with and without special health care needs. Academic Pediatrics, 12(5), 391–398.
Willits, K. A., Nies, M. A., Racine, E. F., Troutman-Jordan, M. L., Platonova, E., & Harris, H. L. (2012). Medical home and emergency department utilization among children with special health care needs: an analysis of the 2005–2006 National Survey of Children with Special Health Care Needs. Journal of Ambulatory Care Management, 35(3), 238–246.
Long, W. E., Cabral, H. J., & Garg, A. (2013). Are components of the medical home differentially associated with child health care utilization, health, and health promoting behavior outcomes? Clinical Pediatrics, 52(5), 423–432.
Blumerg, S. J., Foster, E. B., Satorius, J., Skalland, B. J., Nysse-Carris, K. L., Morrison, H. M., et al. (2012). Design and operation of the National Survey of Children’s Health, 2007. Vital and Health Statistics, 1(55), 1–149.
Blumberg, S. J., Welch, E. M., Upchurch, H. L., Parker, E. K., & Skalland, B. J. (2008). Design and operation of the National Survey of Children with Special Health Care Needs, 2005–2006. Vital and Health Statistics, 1(45), 1–188.
Coleman, K., Reid, R. J., Johnson, E., Hsu, C., Ross, T. R., Fishman, P., et al. (2010). Implications of reassigning patients for the medical home: A case study. Annals of Family Medicine, 8(6), 493–498.
Cooley, W. C., McAllister, J. W., Sherrieb, K., & Kuhlthau, K. (2009). Improved outcomes associated with medical home associated with medical home implementation in pediatric primary care. Pediatrics, 124(1), 358–364.
Rankin, K. M., Cooper, A., Sanabria, K., Binns, H. J., & Onufer, C. (2009). Illinois medical home project: Pilot intervention and evaluation. American Journal of Medical Quality, 24(4), 302–309.
NCQA’s New Distinction in Patient Experience Reporting. http://www.ncqa.org/PublicationsProducts/OtherProducts/PatientExperienceReporting.aspx. Accessed May 20, 2013.
Fayers, P. M., & Machin, D. (2007). Quality of life (2nd ed.). New York: John Wiley & Sons Inc.
Cooley, W. C., McAllister, J. W., Sherrieb, K., & Clark, R. E. (2003). The Medical Home Index: Development and validation of a new practice-level measure of implementation of the Medical Home model. Ambulatory Pediatrics, 3(4), 173–180.
US Department of Health and Human Services. (2011). Building the evidence base for the medical home: What sample and sample size do studies need? (AHRQ Publication No. 11-0100-EF). Rockville, Maryland: Author. http://pcmh.ahrq.gov/. Accessed November 11, 2013.
Statistical Analysis Software for Professionals, Release 9. http://www.stata.com/products/overview.html. Accessed July 15, 2010.
Knapp, C., Madden, V., Baron-Lee, J., Ranka, D., Sun, Y., & Xu, H. (2012). Florida Pediatric Medical Home Demonstration Project Evaluation 2011. Gainesville, FL: Institute for Child Health Policy at the University of Florida.
Knapp, C., Hinojosa, M., Baker, K., Huang, I., & Sloyer, P. (2013). Assessing the congruence of transition preparedness as reported by parents and their adolescents with special health care needs. Maternal and Child Health Journal, 17(2), 352–358.
Knapp, C., Madden, V., Sloyer, P., & Shenkman, E. (2012). Effects of an integrated care system on satisfaction and quality of care for children with special health care needs. Maternal and Child Health Journal, 16(3), 579–586.
Knapp, C., Madden, V., Wang, H., Sloyer, P., & Shenkman, E. (2011). Internet use and e-health literacy of low-income parents whose children have special health care needs. Journal of Medical Internet Research, 13(3), e75.
McAllister, J. W., Cooley, W. C., Cleave, J. V., Boudreau, A. A., & Kuhlthau, K. (2013). Medical home transformation in pediatric primary care—What drives change? Annals of Family Medicine, 11(Suppl 1), S90–S98.
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Knapp, C., Chakravorty, S., Madden, V. et al. Assessing Patient Experiences in the Pediatric Patient-Centered Medical Home: A Comparison of Two Instruments. Matern Child Health J 18, 2124–2133 (2014). https://doi.org/10.1007/s10995-014-1460-9
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DOI: https://doi.org/10.1007/s10995-014-1460-9